HIV Support Source: Development of a Distress Screening Measure for Adults with HIV.

To provide an effective, multidimensional, and psychometrically valid measure to screen for distress among people with HIV, we developed and assessed the psychometric properties of HIV Support Source, a distress screening, referral, and support program designed to identify the unmet needs of adults with HIV and link them to desired resources and support. Development and testing were completed in three phases: (1) item generation and initial item pool testing (N = 375), (2) scale refinement via exploratory factor analysis (N = 220); external/internal item quality, and judging theoretical and practical implications of items, and (3) confirmatory validation (N = 150) including confirmatory factor analysis along with reliability and validity analyses to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk subscales. The final measure comprises 17-items representing four domains of concern: emotional well-being, financial and practical needs, physical well-being, and HIV treatment and sexual health, plus one screening item assessing tobacco and substance use. Our analyses showed strong internal consistency reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales was 0.90 and 0.79, respectively. HIV Support Source is a reliable and valid multidimensional measure of distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess and support the unmet needs of adults with HIV.

CancerSupportSourceTM -Caregiver: Development of a distress screening measure for cancer caregivers.

OBJECTIVE: Given the substantial demands of cancer caregiving, practical and psychometrically sound tools to evaluate distress among cancer caregivers are needed. CancerSupportSourceTM -Caregiver is a distress screening, referral, and support program designed to identify the unmet needs of cancer caregivers and link caregivers to desired resources and support. This study refined and finalized the CancerSupportSource-Caregiver screening measure and examined its psychometric properties. METHODS: Using an analytic sample of 400 caregivers to people with cancer, we first performed item reduction by assessing exploratory factor analysis, external/internal item quality, and judging theoretical and practical implications of items. Confirmatory factor analysis along with reliability and validity analyses were then conducted to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic curve analyses determined scoring thresholds for depression and anxiety risk subscales. RESULTS: Scale refinement resulted in an 18-item measure plus one screening item assessing tobacco and substance use. Items represented five domains of caregiver concerns: emotional well-being, patient well-being, caregiving tasks, finances, and healthy lifestyle. Our analyses showed strong internal consistency and test-retest reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales were 0.95 and 0.87, respectively. CONCLUSIONS: CancerSupportSource-Caregiver is a reliable and valid multidimensional measure of caregiver distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess caregivers' unmet needs and enhance caregiver well-being across the care continuum.

Valued Outcomes in the Cancer Experience (VOICE)™: Development and validation of a multidimensional measure of perceived control.

OBJECTIVE: Enhancing cancer patients' sense of control can positively impact psychological well-being. We developed and assessed the psychometric properties of Valued Outcomes in the Cancer Experience (VOICE)TM, a measure of patients' perceived control over key personal priorities within their cancer experience. METHODS: VOICE construction and testing were completed in three phases with separate participant samples: (1) item generation and initial item pool testing (N = 459), (2) scale refinement (N = 623), and (3) confirmatory validation (N = 515). RESULTS: A 21-item measure was developed that captures cancer patients' sense of control in seven key domains: (1) Purpose and Meaning, (2) Functional Capacity, (3) Longevity, (4) Quality Care, (5) Illness Knowledge, (6) Social Support, and (7) Financial Capability. VOICE demonstrated adequate internal consistency (full-scale α = 0.93; factor α = 0.67-0.89) and adequate to strong convergent and discriminatory validity. SIGNIFICANCE OF RESULTS: VOICE measures cancer patients' perceived control across a diverse range of personal priorities, creating a platform for elevating patient perspectives and identifying pathways to enhance patient well-being. VOICE is positioned to guide understanding of the patient experience and aid the development and evaluation of supportive care interventions to enhance well-being.

CancerSupportSource®-15+: development and evaluation of a short form of a distress screening program for cancer patients and survivors.

PURPOSE: CancerSupportSource® (CSS) is a distress screening program implemented at community-based organizations and hospitals nationwide. The 25-item CSS assesses distress across five domains, with capacity to screen for clinically significant depression and anxiety. This study examined psychometric properties of a shortened form to enhance screening opportunities when staff or patient burden considerations are significant. METHODS: Development and validation were completed in multiple phases. Item reduction decisions were made with 1436 cancer patients by assessing external/internal item quality and judging theoretical and practical implications of items. Pearson correlations and confirmatory factor analysis were conducted on a separate sample of 957 patients to corroborate psychometric properties and dimensionality of the shortened scale. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk scales. RESULTS: Scale refinement resulted in a 15-item short form plus one screening item assessing tobacco and substance use (CSS-15+). At least two items from each CSS domain were retained to preserve multidimensionality. In confirmatory analysis, the model explained 59% of the variance and demonstrated good fit. Correlation between CSS-15+ and 25-item CSS was 0.99, p < 0.001. Sensitivity of 2-item depression and 2-item anxiety risk scales in the confirmatory sample were 0.82 and 0.83, respectively. CONCLUSIONS: CSS-15+ is a brief, reliable, and valid multidimensional measure of distress. The measure retained excellent internal consistency (α = 0.94) and a stable factor structure. CSS-15+ is a practical and efficient screening tool for distress and risk for depression and anxiety among cancer patients and survivors, particularly in community-based settings.

CancerSupportSource-Spanish: Development of a Distress Screening Measure for Spanish-Speaking Hispanic and Latino Individuals with Cancer.

Introduction: CancerSupportSource (CSS), a distress screening and referral program, identifies unmet needs of people with cancer and links them to resources and support. We developed and validated a Spanish-language version (CSS-Spanish) to better serve Hispanic and Latino communities and promote health equity. Methods: The 25-item CSS-Spanish was created leveraging rigorous translation methods and cognitive interviews to ensure cultural relevance and topical breadth. A total of 210 Spanish-speaking Hispanic and Latino individuals completed CSS-Spanish and comparison measures. Psychometric analyses examined dimensionality and statistical validation, and determined scoring thresholds for depression and anxiety risk subscales. Results: CSS-Spanish represented key concerns across five factors and exhibited strong internal consistency and test-retest reliability, convergent validity, and known-groups validity. Risk subscales demonstrated adequate sensitivity. Conclusion: CSS-Spanish is a reliable, valid multidimensional distress screener that rapidly assesses needs of Hispanic and Latino individuals. Embedded depression and anxiety risk flags can support staff in identifying those with high-acuity needs.

Social density of gambling and its association with gambling problems: an initial investigation.

The role of social factors in pathological gambling has received relatively little systematic research. The goal of the current study was to examine the relationship between a target individual's gambling behavior and the gambling behavior among that individual's parents, siblings and five closest friends. The specific aims were, first, to apply a novel brief assessment to study the social density of factors relating to pathological gambling; second, to replicate previously observed findings involving the social aggregation of alcohol and tobacco use; and third, to examine social density findings among the three domains. Participants were 128 frequent gamblers from the Athens, Georgia area, 79.7 % male with a mean age of 34.2 (SD = 11.7). Participants were assessed using the Diagnostic Interview for Gambling Severity for gambling severity, the Alcohol Use Disorders Identification Test for alcohol abuse, the Fagerstrom Test of Nicotine Dependence for tobacco use, and the novel Brief Social Density of Gambling, Alcohol, and Tobacco Assessment. Significant relationships were observed between participants' and friends' activity within all domains: gambling (ps = .001), alcohol use (p < .001) and tobacco use (p < .001). Relationships with friends' activity across domains were less strong. Distinct patterns of associations with parents and siblings were not observed. Thus, social aggregation was observed across the three domains of potentially addictive behaviors, generally with specificity within domains and with friends, not biological relatives. Methodological considerations and potential applications of these findings are discussed.

Perceived COVID-19 pandemic impact and protective factors predicting patient-reported depression and anxiety in individuals living with cancer.

BACKGROUND: The COVID-19 pandemic presents a unique, amplified threat to those living with a cancer diagnosis, but personal factors may play a role in how this affects well-being. This cross-sectional study (1) describes the impacts of COVID-19 on cancer patients' lives, and (2) explores the extent to which specific impacts of COVID-19 and noted protective factors, hope and resilience, predict two crucial patient-reported outcomes, depression and anxiety, after controlling for relevant sociodemographic and clinical factors. METHODS: 520 cancer patients and survivors in the U.S. completed an online survey during the first year of the pandemic and answered questions about COVID-19 areas of impact, psychological well-being, hope, and resilience. Hierarchical regression analyses were used to analyze the unique impact of each group of variables on patient-reported levels of depression and anxiety during the pandemic. RESULTS: Participants strongly endorsed COVID-19 impact across several areas of life, especially social activity, well-being, and ability to acquire basic essentials. Regression models explained a substantial amount of variance in patient-reported depression (R2 = .50, p < .001) and anxiety (R2 = .44, p < .001), revealing COVID-19 financial impact as a significant predictor of depression (ß = 0.07), and COVID-19 family impact as a significant predictor of anxiety (ß = 0.14), even after controlling for the effects of relevant sociodemographic and clinical variables. Additionally, resilience and hope were the largest predictors of both depression (ß = - 0.19 and - 0.37, respectively) and anxiety (ß = - 0.18 and - 0.29), suggesting that they account for unique variance in patient-reported mental health during the COVID-19 pandemic and might serve as important protective factors. CONCLUSIONS: The current results add to existing literature documenting the significant effect of COVID-19 on those living with cancer. COVID-19 impact, including financial and family well-being, as well as positive psychological constructs, hope and resilience, play a crucial role in levels of patient-reported depression and anxiety during the pandemic. As COVID-19 continues to evolve, health care providers should routinely assess psychological well-being and needs related to COVID-19 financial and family impact in an effort to appropriately align individuals with resources and support, and consider how hope and resilience can be fostered to serve as psychological buffers during this time.

Biomarker testing communication, familiarity, and informational needs among people living with breast, colorectal, and lung cancer.

OBJECTIVES: This study aims to characterize patient experiences with biomarker testing, including history of biomarker testing, related communication and education, self-perceived familiarity and informational needs. METHODS: 436 U.S. adults diagnosed with lung (38%), colorectal (35%) or breast cancer (27%) from 2018 to 2022 completed a survey. Two logistic regressions were conducted to predict patients' familiarity with biomarker testing and informational needs. RESULTS: Despite high biomarker testing rates (85%), half of respondents reported low familiarity with biomarker testing and three-quarters reported outstanding informational needs. Regression models indicate those patients who have greater health literacy and report having conversations with their oncologists about biomarker testing have more familiarity with biomarker testing and less informational needs, even after controlling for important sociodemographic factors. CONCLUSIONS: There is an opportunity to improve patients' familiarity with biomarker testing and decrease outstanding informational needs by focusing on factors such as health literacy and patient-provider communication, which could further cultivate patients' understanding of the importance of biomarker testing in cancer care. PRACTICE IMPLICATIONS: These findings underscore the importance of patient-provider relationships and the need for additional tools that assist providers in assessing patients' health literacy and facilitating conversations with patients, especially those focused on complex topics such as biomarker testing.

Pain and Nausea Intensity, Social Function, and Psychological Well-Being among Women with Metastatic Breast Cancer.

Advances in diagnostics and therapeutics have improved prognosis for metastatic breast cancer (MBC). Yet, treatment and disease burden-including experiences of pain and nausea-present practical and emotional challenges. To better support patients and enhance quality of life, deeper understanding of the pathways linking physical and psychological health is needed. To this end, we examined associations of pain and nausea with depression and anxiety among women with MBC. In doing so, we highlighted social function as a potentially important mechanism in this relationship. This observational, cross-sectional study included 148 predominantly non-Hispanic White, highly educated women living with MBC. Multivariate regression models demonstrated that more intense pain and nausea were significantly associated with higher levels of depression and anxiety (p < .001). Causal mediation analyses confirmed significant indirect effects whereby decreases in social function associated with pain and nausea contributed to depression and anxiety. Thus, our findings illustrate decreased social function as one pathway through which pain and nausea contribute to escalation of depression and anxiety. Our results, therefore, underscore the importance of supporting social function among women with MBC to potentially reduce psychological sequelae of pain and nausea.

Emotional perception: meta-analyses of face and natural scene processing.

Functional imaging studies of emotional processing typically contain neutral control conditions that serve to remove simple effects of visual perception, thus revealing the additional emotional process. Here we seek to identify similarities and differences across 100 studies of emotional face processing and 57 studies of emotional scene processing, using a coordinate-based meta-analysis technique. The overlay of significant meta-analyses resulted in extensive overlap in clusters, coupled with offset and unique clusters of reliable activity. The area of greatest overlap is the amygdala, followed by regions of medial prefrontal cortex, inferior frontal/orbitofrontal cortex, inferior temporal cortex, and extrastriate occipital cortex. Emotional face-specific clusters were identified in regions known to be involved in face processing, including anterior fusiform gyrus and middle temporal gyrus, and emotional scene studies were uniquely associated with lateral occipital cortex, as well as pulvinar and the medial dorsal nucleus of the thalamus. One global result of the meta-analysis reveals that a class of visual stimuli (faces vs. scenes) has a considerable impact on the resulting emotion effects, even after removing the basic visual perception effects through subtractive contrasts. Pure effects of emotion may thus be difficult to remove for the particular class of stimuli employed in an experimental paradigm. Whether a researcher chooses to tightly control the various elements of the emotional stimuli, as with posed face photographs, or allow variety and environmental realism into their evocative stimuli, as with natural scenes, will depend on the desired generalizability of their results.

The relationship between pathological gambling and sensation seeking: the role of subscale scores.

Research investigating the relationship between gambling and sensation seeking has yet to establish conclusively whether pathological gamblers (PGs) are more or less sensation seeking than nonpathological gamblers (NPGs). Sensation seeking is usually measured with the Zuckerman et al. (J Consult Clin Psychol 46:139-149, 1978) SS Scale form V (SSS-V). Whereas previous studies relied on the SSS-V total score, the current study uses two samples to demonstrate the importance of the SSS-V subscales, which include Thrill and Adventure Seeking (TA), Experience Seeking (ES), Disinhibition (DS), and Boredom Susceptibility (BS). In two samples, strong intrascale correlations between DS and BS, and between TA and ES, suggest that certain subscales reflect similar underlying characteristics. In both samples PGs displayed higher scores than NPGs on the DS and BS subscales, with mean differences in Sample 2 reaching significant levels for both DS and BS. Results support the notion that the SSS-V can be divided into concepts reflecting actual behavior, based on the DS and BS subscales, and hypothetical behavior, based on the TA and ES subscales. Furthermore, PGs appear to have a preference for the more behavioral subscales while NPGs show a preference for the more hypothetical subscales. Reasons for the subscale divisions and preferences are discussed.

Comparing the utility of a modified Diagnostic Interview for Gambling Severity (DIGS) with the South Oaks Gambling Screen (SOGS) as a research screen in college students.

The South Oaks Gambling Screen (SOGS) is compared in reliability to a modified version of the Diagnostic Interview for Gambling Severity (DIGS-S) for use as a pathological gambling (PG) screen in college students. Seventy-two undergraduates (83.3% male, mean age of 18.8) from the University of Georgia completed the measures, completing a longitudinal design with 3 sessions over a 2-month time period. The DIGS-S and the SOGS demonstrated good internal consistency over the 3 sessions, with Cronbach's Alphas ranging from 0.73 to 0.89, as well as strong concurrent validity, with correlations of .50 to .80 (Ps < .001) between the 2 measures across the 3 sessions. Both Cronbach's alpha and test-retest reliability were higher with the DIGS-S than the SOGS. Given this, and given that the DIGS directly measures symptoms of pathological gambling, future research could benefit from the use of the DIGS-S as a PG screening tool in a college-aged sample.

Factors predicting desired autonomy in medical decisions: Risk-taking and gambling behaviors.

This study investigated factors that influence patients' desired level of autonomy in medical decisions. Analyses included previously supported demographic variables in addition to risk-taking and gambling behaviors, which exhibit a strong relationship with overall health and decision-making, but have not been investigated in conjunction with medical autonomy. Participants (N = 203) completed measures on Amazon's Mechanical Turk, including two measures of autonomy. Two hierarchical regressions revealed that the predictors explained a significant amount of variance for both measures, but the contribution of predictor variables was incongruent between models. Possible causes for this incongruence and implications for patient-physician interactions are discussed.

Measuring cognitive distortions in pathological gambling: review and meta-analyses.

There is broad agreement that cognitive distortions are an integral component of the development, maintenance, and treatment of pathological gambling. There is no authoritative catalog of the distortions that are observed more frequently in pathological gamblers than in others, but several instruments have been successfully developed that measure various distortions of interest, which are reviewed. All of the prominent instruments include measures of the illusion of control (perceiving more personal control over events than is warranted), and almost all include measures of gambler's fallacy (the belief that after a string of one event, such as a coin landing heads, an alternative event, such as the coin landing tails, becomes more likely). Beyond these two errors, there is scant consensus on relevant errors, and a wide variety has been studied. Meta-analyses were conducted on differences between PGs and non-PGs in scores on six published instruments that were developed to measure distortions in gamblers. All instruments reveal large effects using Hedge's g statistic, suggesting that the impact of distortions on PG is robust. Several subscales, assigned diverse names by scale authors, can be viewed as reflecting common distortions. Those judged to assess gambler's fallacy show evidence of more robust effects sizes than those that assess illusion of control. It is recommended that future research focus more specifically on the impact of particular distortions on gambling disorders.

Personality correlates of pathological gambling derived from Big Three and Big Five personality models.

Personality traits have proved to be consistent and important factors in a variety of externalizing behaviors including addiction, aggression, and antisocial behavior. Given the comorbidity of these behaviors with pathological gambling (PG), it is important to test the degree to which PG shares these trait correlates. In a large community sample of regular gamblers (N=354; 111 with diagnoses of pathological gambling), the relations between measures of two major models of personality - Big Three and Big Five - were examined in relation to PG symptoms derived from a semi-structured diagnostic interview. Across measures, traits related to the experience of strong negative emotions were the most consistent correlates of PG, regardless of whether they were analyzed using bivariate or multivariate analyses. In several instances, however, the relations between personality and PG were moderated by demographic variable such as gender, race, and age. It will be important for future empirical work of this nature to pay closer attention to potentially important moderators of these relations.

Evaluating the South Oaks Gambling Screen with DSM-IV and DSM-5 criteria: results from a diverse community sample of gamblers.

Despite widespread use, the South Oaks Gambling Screen (SOGS) has been criticized for excessive false positives as an indicator of pathological gambling (PG), and for items that misalign with PG criteria. We examine the relationship between SOGS scores and PG symptoms and convergent validity with regard to personality, mood, and addictive behaviors in a sample of 353 gamblers. SOGS scores correlated r = .66 with both DSM-IV and DSM-5 symptoms, and they manifested similar correlations with external criteria (intraclass correlation of .95). However, 195 false positives and 1 false negative were observed when using the recommended cut point, yielding an 81% false alarm rate. For uses with DSM-IV criteria, a cut point of 10 would retain high sensitivity with greater specificity and fewer false positives. For DSM-5 criteria, we advocate a cut point of 8 for use as a clinical screen and a cut point of 12 for prevalence and pseudo-experimental studies.

Cognitive distortions as a component and treatment focus of pathological gambling: a review.

The literature on the role of cognitive distortions in the understanding and treatment of pathological gambling (PG) is reviewed, with sections focusing on (a) conceptual underpinnings of cognitive distortions, (b) cognitive distortions related to PG, (c) PG therapies that target cognitive distortions, (d) methodological factors and outcome variations, and (e) conclusions and prescriptive recommendations. The conceptual background for distortions related to PG lies in the program of heuristics and biases (Kahneman & Tversky, 1974) as well as other errors identified in basic psychology. The literature has focused on distortions arising from the representativeness heuristic (gambler's fallacy, overconfidence, and trends in number picking), the availability heuristic (illusory correlation, other individuals' wins, and inherent memory bias), and other sources (the illusion of control and double switching). Some therapies have incorporated cognitive restructuring within broader cognitive-behavioral therapies, with success. Other therapies have focused more narrowly on correcting distorted beliefs, more often with limited success. It is concluded that the literature establishes the role of cognitive distortions in PG and suggests therapies with particularly good promise, but is in need of further enrichment.